The day came and went with reflection on where we stand with treatment of substance use disorder and mental health conditions, during a pandemic no less. An awareness event scheduled for the summer was cancelled due to the pandemic. Our awareness events were mostly virtual. I put up some ribbons, as did my neighbors.
Unfortunately, overdose deaths are spiking nationally. We are still facing barriers to treatment. In Vermont, there are still prior authorization requirements for buprenorphine, especially injectable forms. There are federally mandated requirements for methadone. We have been unable to pass a bill to decriminalize buprenorphine without a prescription. There is still lack of access to treatment in Vermont, nothing much beyond a 21 to 28 day stay, even though experts agree on a 90 day step down treatment approach. There is a lack of sober supportive housing, and no place to go (sometimes other than jail) if you are one of many evicted from sober living.
Other countries, like Switzerland have adopted strategies to care for people who use drugs. People who, like our son Sean, used sporadically and didn’t see MAT as a need (though I disagreed with him on that point) These aren’t outlandish ideas, Switzerland certainly is pretty conservative in many areas. It is sensible to promote harm reduction, lower barriers to treatment, focus law enforcement on big-time dealers, focus on treatment not criminalization of use.
I am certain that rapid access treatment will lower diversion. Allowing more liberal use of methadone, and treating people instead of putting them in jail will decrease use. Treatments have to support people, housing is an important part of that strategy. Law enforcement is part of the strategy as well.
If you haven’t read Fentanyl Inc, by Ben Westhoff, it is well researched and captivating look at how these chemicals are radically changing the substances used recreationally, with often lethal consequences.
Finally, we need to start with prevention. Mental health care for our kids is of upmost importance. The record numbers of suicides and substance use disorders is a symptom of our culture. Social media has not helped. Iceland has a great prevention model where substances aren’t promoted, sports and connection with pers and families are. There are few liquor outlets, no cannabis stores, and many teen recreation centers.